title: Infarct size and mortality in patients with proximal versus mid left anterior descending artery occlusion: the Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction (INFUSE-AMI) trial.
abstract: OBJECTIVE
  This study aimed to compare infarct size and clinical outcomes in patients with proximal versus mid left anterior descending (mLAD) infarction.
  
  
  BACKGROUND
  The extent of myocardium at risk is an important prognostic determinate in patients with ST-segment elevation myocardial infarction.
  
  
  METHODS
  The INFUSE-AMI trial randomized patients with anterior ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with bivalirudin anticoagulation to intracoronary (IC) bolus abciximab versus no abciximab and to thrombus aspiration versus no aspiration. The primary end point was magnetic resonance imaging infarct size (% of left ventricular mass) at 30 days. Lesion location was independently assessed and was defined as proximal (pLAD) if present before or at first significant septal perforator branch, or mLAD if beyond.
  
  
  RESULTS
  Among 452 patients, 292 (64.7%) had pLAD and 159 (35.3%) had mLAD occlusions. Patients with pLAD infarcts were significantly more likely to have Killip class >1 heart failure and ejection fraction <40% and to present earlier to the hospital. Proximal LAD infarcts had significantly lower rates of final Thrombolysis In Myocardial Infarction flow 3 and procedural success but similar rates of myocardial blush grade 2/3 and ST-segment resolution compared with mLAD infarcts. Infarct size at 30 days was significantly greater in the pLAD group (19.3% [9.2-25.9] vs 14.3% [6.2-18.9], P < .0001). Mortality at 30 days was also higher in the pLAD group (4.2% vs 0.6%, P = .04). The effect of IC abciximab on reducing infarct size was comparable in both groups.
  
  
  CONCLUSIONS
  ST-segment elevation myocardial infarction caused by pLAD compared with mLAD occlusion results in larger infarcts and greater mortality even with contemporary reperfusion therapy.
authors.affiliation: New York Methodist Hospital, Brooklyn, NY, USA. sjb9005@nyp.org
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: Joe
authors.initials: J
authors.lastname: Dizon
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: Magdi
authors.initials: M
authors.lastname: El-Omar
authors.forename: Jan-Henk
authors.initials: JH
authors.lastname: Dambrink
authors.forename: Philippe
authors.initials: P
authors.lastname: Genereux
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Keith
authors.initials: K
authors.lastname: Oldroyd
authors.forename: Helen
authors.initials: H
authors.lastname: Parise
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D003331:Coronary Vessels; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D007269:Injections, Intra-Arterial; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D015996:Survival Rate / Q000639:trends; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab